Obstructive sleep apnea and pulmonary hypertension

Opstruktivna apneja u spavanju najčešći je poremećaj disanja tijekom spavanja. Riječ je o relativno čestom, ali nedovoljno prepoznatom medicinskom problemu koji je povezan s brojnim kroničnim bolestima poput hipertenzije, metaboličkog sindroma, šećerne bolesti i slično. Opstrukcija dišnog puta tijekom spavanja dovodi do smanjenog ili odsutnog disanja što ometa respiracijsku funkciju i kvalitetu sna. Simptomi uključuju hrkanje, epizode prestanka disanja tijekom spavanja, dnevnu pospanost i umor. Najveći rizični čimbenici su starija ţivotna dob, pretilost i odreĎene anatomske anomalije. Na temelju anamneze, rješavanja dostupnih kratkih upitnika kao metoda probira i kliničkog pregleda moţemo postaviti sumnju na postojanje poremećaja disanja vezanog uz spavanje, a definitivnu dijagnozu potvrdit će nalaz cjelonoćne polisomnografije. Zasad najčešća metoda liječenja je primjena kontinuiranog pozitivnog tlaka u dišne putove (CPAP) preko nazalne ili oronazalne maske. Za uspjeh liječenja najvaţnija je kontinuirana i vremenski odgovarujuće duga primjena. U blaţih slučajeva za poboljšanje simptoma moţe biti dostatna i samo promjena ţivotnih navika, prvenstveno fizička aktivnost i gubitak tjelesne teţine. Dugotrajni utjecaj hipoksemije i hiperkapnije prisutne u pacijenata s apnejama u spavanju dovode do promjena na plućnoj vaskulaturi i razvoja plućne hipertenzije. Procjenjuje se da oko 20% pacijenata s opstruktivnom apnejom u spavanju ima i plućnu hipertenziju. Primjena CPAP-a smanjuje tlak u plućnoj arteriji i plućni vaskularni otpor i time olakšava simptome i poboljšava prognozu bolesnicima s opstruktivnom apnejom u spavanju i plućnom hipertenzijom.Obstructive sleep apnea is the most common sleep-related breathing disorder. This is a relatively common, but insufficiently recognized medical problem associated with many chronic diseases such as hypertension, metabolic syndrome, diabetes etc. Airway obstruction during sleep leads to reduced or absent breathing which interferes with respiratory function and sleep quality. Symptoms include snoring, episodes of sleep apnea, daytime sleepiness, and fatigue. The biggest risk factors are older age, obesity and certain anatomical anomalies. Based on the medical history, evaluation by the available short questionnaires as a method of screening and clinical examination, the existence of sleep-related breathing disorders could be suspected, and the definitive diagnosis will be confirmed by the finding of all-night polysomnography. So far, the most common method of treatment is the application of continuous positive pressure on the airways (CPAP) through the nasal or oronasal mask. Patient adherence is the most important to achieve positive treatment effects. In milder cases, a change in lifestyle, primarily physical activity and weight loss, may be sufficient to improve symptoms. The long-term effects of hypoxemia and hypercapnia present in patients with sleep apnea lead to changes in the pulmonary vasculature and the development of pulmonary hypertension. It is estimated that about 20% of patients with obstructive sleep apnea also have pulmonary hypertension. The use of CPAP reduces pulmonary artery pressure and pulmonary vascular resistance and thus alleviates symptoms and improves the prognosis in patients with obstructive sleep apnea and pulmonary hypertension